NCCN Evidence Blocks™
User Guide
In cancer care, the most important value perspective is that of the individual patient. NCCN Evidence Blocks™ educate
providers and patients about the efficacy, safety, and affordability of systemic therapy. NCCN Evidence Blocks™ are a
starting point for shared decision-making based on a common vocabulary of choices and values.
The NCCN Evidence Blocks™ are published in a new version of the NCCN Clinical Practice Guidelines in Oncology (NCCN
Guidelines®) and are intended as a visual representation of five key value measures that provide important information about
specific NCCN Guidelines® recommendations: efficacy, safety, quality and quantity of evidence, consistency of evidence, and
affordability.
By adding affordability to the existing National Comprehensive Cancer Network® (NCCN®) criteria for evaluating treatment
options, patients will be empowered to identify, alongside their physician, optimal treatment based on clinical and economic
considerations that are of most value to them.
NCCN Guidelines with NCCN Evidence Blocks™ are an additional NCCN resource—separate from the NCCN Guidelines—
that are currently available free of charge on NCCN.org. NCCN intends for the library of NCCN Guidelines with NCCN
Evidence Blocks™ for systemic therapies to be published by the end of 2017.
For more information, visit
NCCN.org/EvidenceBlocks.
NCCN
Guidelines Version
1.2016
Chronic Myelogenous Leukemia
TM
TM
NCCN EVIDENCE BLOCKS
CATEGORIES
ANDBlocks
DEFINITIONS
NCCN
Evidence
5
4
3
2
1
NCCN Guidelines Index
CML Table of Contents
NCCN EVIDENCE BLOCKS EXAMPLEDiscussion
TM
5
NCCN
EVIDENCE BLOCKS CATEGORIES AND DEFINITIONS
E = Efficacy of
Regimen/Agent
4
5
E = Efficacy of Regimen/Agent
S = Safety of Regimen/Agent
S = Safety of Regimen/Agent
4
3
Q = Quality
of EvidenceQ = Quality of Evidence
3
2
C = Consistency of Evidence
C = Consistency
of Evidence
2
1
A
=
Affordability
of
Regimen/Agent
A = Affordability
of Regimen/Agent
1
E S Q C A
E S Q C A
Efficacy of Regimen/Agent
© 2015 National Comprehensive Cancer Network®
5
Highly effective:Oftenprovideslong-termsurvivaladvantage
or has curative potential
4
Very effective: Sometimesprovideslong-termsurvival
advantage or has curative potential
3
Moderately effective: Modest, no, or unknown impact on
survival but often provides control of disease
2
Minimally effective: Modest, no, or unknown impact on
survival and sometimes provides control of disease
1
Palliative:Providessymptomaticbenefitonly
Safety of Regimen/Agent
5
Usually no meaningful toxicity: Uncommon or minimal side
effects.Nointerferencewithactivitiesofdailyliving(ADLs)
4
Occasionally toxic:Raresignificanttoxicitiesorlow-grade
toxicities only. Little interference with ADLs
3
Mildly toxic: Mild toxicity that interferes with ADLs is common
2
Moderately toxic:Significanttoxicitiesoftenoccur;life
threatening/fatal toxicity is uncommon. Interference with ADLs
is usual
1
Highly toxic: Usuallysevere,significanttoxicitiesorlife
threatening/fatal toxicity often observed. Interference with ADLs
is usual and/or severe
NCCN.org/EvidenceBlocks
E=4
Example Evidence Block
S=4
5
E=4
Q=3
S=4
4
Q=3
C=4
3
C=4
A=3
2
A=3
1
E S Q C A
E S Q C A
®
© 2015 National Comprehensive Cancer Network
Quality of Evidence
5
High quality: Multiplewell-designedrandomizedtrialsand/or
meta-analyses
4
Good quality:Severalwell-designedrandomizedtrials
3
Average quality:Lowqualityrandomizedtrialsorwelldesignednon-randomizedtrials
2
Low quality: Case reports or clinical experience only
1
Poor quality: Little or no evidence
Consistency of Evidence
5
Highly consistent: Multiple trials with similar outcomes
4
Mainly consistent: Multiple trials with some variability in
outcome
3
May be consistent: Fewtrialsoronlytrialswithfewpatients;
lowerqualitytrialswhetherrandomizedornot
2
Inconsistent: Meaningful differences in direction of outcome
between quality trials
1
Anecdotal evidence only: Evidence in humans based upon
anecdotal experience
Affordability of Regimen/Agent (includes drug cost, supportive
care, infusions, toxicity monitoring, management of toxicity)
5
4
3
2
1
Very inexpensive
Inexpensive
Moderately expensive
Expensive
Very expensive
Version 1.2016, 09/09/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Evidence BlocksTM, NCCN Guidelines®, and this illustration may not be reproduced in any form without the express written permission of NCCN®.
EB-1